Not understanding why some use Insulin with T2D IR

[WAGR57]

In reading the posts on this forum, I see there are some T2s using insulin. I can see using insulin if you are onset T1 but if you are IR T2D would insulin not be a bad thing?

Here is my understanding of T2 types:

IR Insulin Resistant: Target cells are not accepting the insulin hormone and pancreas starts making too much insulin.

Onset Type 1 or LADA: The pancreas isn’t making the insulin hormone like it used to and is on the path to not being able to make any at all.

TOFI (Thin Outside Fat Inside) : Liver and Pancreas have too much fat and this causes T2. A good low carb diet with intermittent fasting can remedy this condition. Not sure if meds are required or recommended.

 

[Caprock94]

Two reasons would be my guess. Some T2s aren't willing to change their diet.....therefore they need more insulin to bring blood sugar numbers down. Second reason would be even though T2 and insulin resistant, perhaps they have been diabetic for a long time and their pancreas doesn't produce enough to cover the carbs. Combination of both possible as well.

 

[Rokaab]

Also for those on steroids (and possibly some other meds) it can be nigh on impossible to control without extra insulin

 

[Andydragon]

Two reasons would be my guess. Some T2s aren't willing to change their diet.....therefore they need more insulin to bring blood sugar numbers down. Second reason would be even though T2 and insulin resistant, perhaps they have been diabetic for a long time and their pancreas doesn't produce enough to cover the carbs. Combination of both possible as well.

willing implies blame that isn't always the case. there is a lot of NHS info pushing diets that are not that suitable and selling the information that T2 is progressive and will move to insulin. Low carb is not generally sold by the NHS as the right option. The recommended diets actively push for "healthy" carbs, low fat, lots of fruit and veg. Follow these and as it turns out the carbs will keep bloods on the rise.

I only know about low carb because I found these forums.

I have personally been told that the expectation is that every type 2 will progress onto insulin eventually. This was by a diabetic nurse

 

[XxTinkerxx]

willing implies blame that isn't always the case. there is a lot of NHS info pushing diets that are not that suitable and selling the information that T2 is progressive and will move to insulin. Low carb is not generally sold by the NHS as the right option. The recommended diets actively push for "healthy" carbs, low fat, lots of fruit and veg. Follow these and as it turns out the carbs will keep bloods on the rise.

I only know about low carb because I found these forums.

I have personally been told that the expectation is that every type 2 will progress onto insulin eventually. This was by a diabetic nurse

I have been told exactly that too, and told to eat porridge and brown rice.

 

[miahara]

I'm T2 and after my initial diagnosis adopted a low carb diet and brought my BG down to 'remission level', sadly this didn't last long and BG started to climb again. My GP prescribed restarting gliclazide ( I'd stopped it with her agreement) but BG didn't come down so I was referred to secondary care and tests revealed that I wasn't insulin resistant but insulin deficient as my pancreas had decided to go on strike. Now with the aid of insulin my BG level is better than its ever been and I can enjoy a wider range of food so long as I balance carb intake with insulin.

 

[Resurgam]

Pretty obvious why when you read the advice given to all newly diagnosed diabetics - poor little pancreases must be sobbing hysterically after a day-load of carbs as advised.

 

[sonia2016]

Oh, if only all type 2 diabetics fitted into WAGR57's understanding of type 2 diabetes. We are all a bit different. In fact there are many type 2s who are not insulin resistant and require insulin to bring their blood sugars down. And as others have commented the medically recommended diet for diabetes is not low carb. I only found the low carb approach after stumbling across the blog "Blood Sugar 101" by Jenny Ruhl and the New Atkins diet book while on holiday in the USA. My Diabetes Nurse does not really approve but as I brought my A1c down into the normal range within a year and came off metformin within 3 years, all the doctors I see are surprised and don't comment on the diet.

 

[HSSS]

I'm T2 and after my initial diagnosis adopted a low carb diet and brought my BG down to 'remission level', sadly this didn't last long and BG started to climb again. My GP prescribed restarting gliclazide ( I'd stopped it with her agreement) but BG didn't come down so I was referred to secondary care and tests revealed that I wasn't insulin resistant but insulin deficient as my pancreas had decided to go on strike. Now with the aid of insulin my BG level is better than its ever been and I can enjoy a wider range of food so long as I balance carb intake with insulin.

Out of interest what makes you type 2 rather than a LADA? As a slim diabetic who struggled to control levels with low carb especially early in the the disease and identified with insulin deficiency it seems more likely to me

In fact there are many type 2s who are not insulin resistant and require insulin to bring their blood sugars down.

Same question really. Insulin resistance is core to type 2 from my understanding. Where are you looking for explanations of what type 2 is please?

 

[miahara]

Out of interest what makes you type 2 rather than a LADA? As a slim diabetic who struggled to control levels with low carb especially early in the the disease and identified with insulin deficiency it seems more likely to me


Same question really. Insulin resistance is core to type 2 from my understanding. Where are you looking for explanations of what type 2 is please?

I did suspect LADA but the endocrinologist I saw didn't support my hypothesis and I'm not sure that it really makes a difference to my treatment anyway as insulin seems to be working pretty well for me.

 

[HSSS]

I did suspect LADA but the endocrinologist I saw didn't support my hypothesis and I'm not sure that it really makes a difference to my treatment anyway as insulin seems to be working pretty well for me.

I guess having established a deficit of insulin (therefore unlikely to be put into reverse/remission in the way IR can be) and treatment is working the end result is the same. Perhaps it’s just my personal outlook that would demand a definitive diagnosis. Yours is not the only endo to dismiss the concept of LADA (if that’s what did in fact happen), others see it differently. So much of medicine is based on subjective opinion still sadly.

 

[WAGR57]

I'm T2 and after my initial diagnosis adopted a low carb diet and brought my BG down to 'remission level', sadly this didn't last long and BG started to climb again. My GP prescribed restarting gliclazide ( I'd stopped it with her agreement) but BG didn't come down so I was referred to secondary care and tests revealed that I wasn't insulin resistant but insulin deficient as my pancreas had decided to go on strike. Now with the aid of insulin my BG level is better than its ever been and I can enjoy a wider range of food so long as I balance carb intake with insulin.

I totally see the use of insulin in this case. Tests have shown your pancreas is no longer making insulin like it used to( aka as LADA) .

 

[WAGR57]

I guess having established a deficit of insulin (therefore unlikely to be put into reverse/remission in the way IR can be) and treatment is working the end result is the same. Perhaps it’s just my personal outlook that would demand a definitive diagnosis. Yours is not the only endo to dismiss the concept of LADA (if that’s what did in fact happen), others see it differently. So much of medicine is based on subjective opinion still sadly.

Totally agree with your last sentence.

 

[Fenn]

For me, I spent a long time, maybe 8 years keto and in remission/cured, I was the original low carb warrior.

Dont ask me why but does not matter what I eat, I cannot get numbers down, my sister is T2 on insulin, both my children are diabetic, my brother (pre), my mother, in fact its hard to find someone in my blood line that isn't.

So I am left with a choice? Take insulin or stay between 18-25 bg

I hope and prey anyone that doesn't think insulin is a good idea is ever faced with it, yes its a terrible idea, no it makes little sense,

NO ITS NOT BECAUSE I WANT TO EAT JUNK FOOD AND IM TOO LAZY TO DIET

 

[HSSS]

I hope and prey anyone that doesn't think insulin is a good idea is ever faced with it, yes its a terrible idea, no it makes little sense,

NO ITS NOT BECAUSE I WANT TO EAT JUNK FOOD AND IM TOO LAZY TO DIET

I think insulin is a good idea when there isn’t a better alternative. In some situations it is the best option, in others a poor one. The key is knowing what options (If any) are available, how well each might work and what suits you.

I sincerely hope no one lays that accusation falsely at your feet. That said some people would rather take insulin and eat junk and not diet. Such is their right if they are aware f what they are doing.

 

[Fenn]

I apologise for the above pathetic rant

 

[SilverK]

Two reasons would be my guess. Some T2s aren't willing to change their diet.....therefore they need more insulin to bring blood sugar numbers down. Second reason would be even though T2 and insulin resistant, perhaps they have been diabetic for a long time and their pancreas doesn't produce enough to cover the carbs. Combination of both possible as well.

I think it’s a little unfair to say that people are maybe on insulin because they’re not willing to change their diet. Every one is different. I’m on insulin and also eat low carb. If I don’t then my sugars misbehave. - I’m currently paying for a very small cookie (5g carbs) that I ate two days ago, as part of my otherwise carb free lunch and suitably balanced with fast acting insulin. Two days and my sugar levels are still raised. Not a lot, a couple of points, but still depressing. Not seeing any Christmas treats on the horizon. Without insulin I dread to think where I’d be as fat and protein also raise my levels. The only difference is in the spike. No spike, just everything raised for the next few days.
Sorry to butt in, but it struck a nerve.

 

[bulkbiker]

In fact there are many type 2s who are not insulin resistant and require insulin to bring their blood sugars down.

Although they are likely misdiagnosed as T2 when in fact they are one of the T1 spectrums?

 

[Caprock94]

I think it’s a little unfair to say that people are maybe on insulin because they’re not willing to change their diet. Every one is different. I’m on insulin and also eat low carb. If I don’t then my sugars misbehave. - I’m currently paying for a very small cookie (5g carbs) that I ate two days ago, as part of my otherwise carb free lunch and suitably balanced with fast acting insulin. Two days and my sugar levels are still raised. Not a lot, a couple of points, but still depressing. Not seeing any Christmas treats on the horizon. Without insulin I dread to think where I’d be as fat and protein also raise my levels. The only difference is in the spike. No spike, just everything raised for the next few days.
Sorry to butt in, but it struck a nerve.

My point is still valid. I know some T2s that aren't willing to change their diet. You, however, aren't one of them. Neither am I. In fact, most here don't fit that category since most here are indeed making changes and doing their best.

 

[zand]

I think some don't change their diet because what they are told to do simply doesn't work. It's soul destroying when you follow what your doctor says to the letter and it doesn't work.